Organization
LOMA LINDA PSYCHIATRIC MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LIBERTY MACIAS NP (PARTNER)
(909) 792-6886
Entity
Organization
Contact information
Practice address
1200 CALIFORNIA ST STE 140, REDLANDS, CA 92374-2946
(909) 880-4200
Mailing address
PO BOX 1303, LOMA LINDA, CA 92354-1303
(909) 880-4200
(888) 505-0620
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
56486
CA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
95002264
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
127629
UIN
CA
Enumeration date
08/04/2016
Last updated
01/10/2025
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